| Doctor Name: | DEVIN SCOTT KENJI WONG |
| NPI Number: | 1942521232 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | DO NOT HAVE ONE YET |
| Business Practice Address: | 2200 Tydd St Eureka, CA - 955011284 |
| Business Phone Number: | 7074411624 |
| Business Fax Number: | 7074411253 |
| Mailing Address: | 670 9th Street, Suite 203 ARCATA |
| State: | CA |
| Postal Code: | 955216249 |
| Phone Number: | 7078268633 |
| Fax Number: | 7078268638 |
| NPI Enumeration Date: | 06/21/2010 |
| NPI Last Update Date: | 10/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | DO NOT HAVE ONE YET |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |